Provider Demographics
NPI:1134190663
Name:ROUBOS, ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:ROUBOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 E CAMELBACK RD
Mailing Address - Street 2:BLDG 26 UNIT 601
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2616
Mailing Address - Country:US
Mailing Address - Phone:616-283-3979
Mailing Address - Fax:
Practice Address - Street 1:7014 E CAMELBACK RD
Practice Address - Street 2:2140
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1227
Practice Address - Country:US
Practice Address - Phone:480-945-9971
Practice Address - Fax:480-990-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI997339152W00000X
AZ2160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900G065180OtherBCBS ID NUMBER
MI3494254Medicaid
MIU72285Medicare UPIN
MI900G065180OtherBCBS ID NUMBER